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Dying Destitute in the United States

Dead broke

Dying is expensive. Consider the popular images associated with the laying to rest process— painstakingly preserved bodies made-up with cosmetics, entombed in a vault, in a well-manicured cemetery, marked by a stately granite headstone. This ritual costs, on average, over $6,000. Cremation is emerging as a cheaper alternative, but it still costs, on average, over $3,000. The monetary expenses associated with death are undoubtedly burdensome to many Americans, but for America’s most vulnerable and destitute citizens these expenses can be insurmountable. What happens when relatives are unwilling, or unable, to pay for the decedent to be buried? Who pays, and how much, for the burial of the homeless man who died alone and without family?

States vary in how they approach the issue of providing for indigent burial. Approximately sixteen states, including Illinois, Massachusetts, and Wisconsin, administer programs at the state level whereby state funds are allocated for reimbursing cemeteries and funeral homes that prepare and lay to rest indigent residents who passed away in the state. A larger contingent of states administer and fund indigent burial programs at the county level. Some states, such as Florida, require its counties to adopt and administer indigent burial assistance programs consistent with state law. In states like North Carolina, where a program does not exist at the state level and counties are not required to create programs, the existence and character of indigent burial programs vary by county and municipality. 

Amongst the states, indigent burial programs vary greatly in who foots the bills, the services provided, eligibility criteria, and how much they are willing to compensate the funeral home and cemetery. In all this diversity, one commonality appears to be that all these programs provide compensation to funeral homes and cemeteries that is far below the value of their services. For example, the Massachusetts Funeral Directors Association maintains that the least expensive burial will typically cost approximately $3,000. Yet, the state will only reimburse the funeral home for up to $1,100 of its expenses. Budget balancing is a concern, but it is patently unfair to funeral directors that this number has not been adjusted since 1983. It could be worse though-- the maximum reimbursement in Oregon, for example, is $650. 

An obvious concern is preventing people from taking advantage of the system when there actually are assets available to pay for a decedent's burial. States vary in the criteria used to determine eligibility. Most programs administered at the state level use Medicaid eligibility as a proxy criteria for determining who qualifies for indigent burial services. An example of an alternative criteria is that used by Palm Beach County, Florida, where income eligibility is based on the last 3 months income and must fall within the 110% Federal Poverty Guidelines. Some states will not pay for an indigent's burial where there is family available to claim the remains, regardless of the assets available to the decedent's relations.

The services provided by indigent burial programs range from generous to miserly. For instance, in Palm Beach County, Florida, the indigent decedent is laid to rest in a cloth covered, wooden casket. Hearse transportation is provided for the decedent (but not the family), and there is a grave-side service with a viewing, provided at a County-contracted cemetery. In contrast, in Leon County, Florida, grave-side ceremonies are prohibited-- friends and relatives are not permitted to be present at the time of the burial. Also, burial takes place at the county pauper cemetery. 

The role of social welfare programs is a hot button issue, but not much attention is given to what is the role of the state in ensuring that its citizens' remains are disposed of in a respectful and sanitary way. To many, state assistance is strictly for the living. It seems worth asking, especially as state budgets grow tight, "if we no longer treat the dead with dignity, what hope is there for the living?"

Dave Brennan

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